Here's Why Republicans Will Never Reform Health Care

Philip Klein
writes that Obamacare will get blamed for all sorts of
problems in the American health care system, even problems that
would have existed with or without the law:

Given that the law was sold as a way to fix a broken health care
system, rightly or wrongly, the law is going to be blamed for any
persistent problems. It’s impossible for Americans to sort out
whether a given change took place as a result of the law or
whether it would have happened anyway. If they don’t like a
change to their health care situation that occurred after a giant
new law went into effect, they’re going to blame that giant new
law.

If I were a vulnerable Democrat incumbent in 2014, I wouldn’t
want to pin my re-election hopes on being able to convince angry
voters that changes that they hate would have happened with or
without the health care law. “Correlation doesn’t equal
causation” is not exactly a winning campaign slogan.

Klein is right. And his analysis explains why Republicans have
had the same health policy strategy for 20 years: Nominally
favoring big fixes to our health care system but not enacting
them.

Many Republicans say they favor converting the tax exclusion for
employer-provided health insurance into a tax credit. This would
help some people with moderate incomes afford to buy health
insurance. It would also increase the cost of health care for
many people, particularly those with high incomes or high-cost
health plans. That would upset a lot of people.

Many Republicans say they want to equalize the tax treatment of
employer-provided health insurance and individually-purchased
health insurance. This would lead some employers to drop
coverage, which would upset a lot of people.

Many Republicans say they favor allowing health insurance plans
to be sold across state lines. That would lead health insurers to
exit many states' insurance markets, clustering in those states
that have insurer-favorable regulations, much in the way credit
card issuance is now concentrated in South Dakota, Nevada and
Delaware. That would lead to the cancellation of a lot of
existing health insurance plans in the individual market, which
would upset a lot of people.

Those problems would cluster on top of problems that arise all
the time in health insurance markets, absent any public policy
change: Rising prices, doctors changing what insurances they
accept, employers changing their benefit offerings, whatever.
Conservative health reformers would take the blame for all the
problems their reforms created, and many problems they didn't,
just as has happened to liberals with Obamacare.

So it's no surprise Republicans haven't enacted any of the big
reforms they like to talk about. The only reforms they've been
able to implement are ones that hand out new benefits without
creating any losers: A new prescription drug benefit in Medicare
and expanded tax advantages for health spending, such as Health
Savings Accounts.

These policies haven't addressed the problems of high costs or of
lack of insurance for many people under age 65. But they also
haven't exposed Republicans to attack for causing people's health
plans to change.

Liberals chose to reform health
policy despite the political risks, because their political
coalition includes the people who are
most extensively screwedby
the health policy status quo. Conservatives have decided that
cynicism is a better political strategy, for the reasons Klein
inadvertently lays out. They're probably right on the politics,
but that's nothing to be proud of.